Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Wednesday, February 12, 2014

I want to point you to a psychiatry blog I happened upon not long ago, In White Ink, written by psychiatrist Dr. Maria Yang. There was a post that moved me, and I went to comment, but there was no place to do so.

Now, Dr. Yang is in the process of moving her blog and she's put up a post about My Brief History on the Internet. My favorite part of the post is where she marries one of her blog readers!Dr. Yang writes:

I started meet­ing peo­ple who read my writ­ing online. The inter­net was a dynamic and excit­ing place.
I started feel­ing ambiva­lent about writ­ing online. I closed down
com­ments because anony­mous peo­ple left state­ments like, “ALLPSYCHIATRISTSSHOULDDIE” and “YOU’RE A PSYCHIATRIST, YOUKILLCHILDREN”. A physi­cian who wrote a blog under a pseu­do­nym was revealed
in court. I wor­ried that my writ­ing wasn’t fic­ti­tious enough, that
maybe my sto­ries weren’t purely coin­ci­den­tal. My mind gen­er­ated
cat­a­stro­phes: Some­one might read a story and think I was talk­ing
about them! They would sue me and I would lose my license! Other
doc­tors would judge me! I would never recover! Even if I did, one of
those com­menters who hate psy­chi­a­trists would then kill me! So I shut down that blog. The inter­net was a scary and dan­ger­ous place.

At Shrink Rap, we've been to all those places, since we started blogging in Spring of 2006. We do have the best of readers, who are bright, articulate, and thoughtful, and we don't get death threats or personal accusations, but part of this post resonated for me.What we do see a lot of in our comment section are stories about people who are, from their point of view only (the psychiatrist's side is never solicited) who have been mistreated by the mental health system. I like getting the links, because I do like to know that these issues are out there. What I don't like, is the insistence that the patient is always the victim of the evil psychiatrist, that they played no role and if they behaved in an aggressive way that provoked unwarranted treatment, then it's obviously because the evil psychiatrist was not listening to their concerns and any reasonable, mentally well, human being would respond in such a fashion.

If that's not enough, then commenters go on to talk about how psychiatrists are all about "power trips." Trust me on this, any day a psychiatrist calls the police for an out-of-control patient, it's BAD day. There's no, "Honey, what a great day, I got to call the cops and commit someone." It's traumatic, upsetting, and draining for the psychiatrist. And, I'm well aware that it's traumatic, upsetting, and draining for the patient, and no doctor likes to upset their patients. It's a much better day when things are congenial and patients like the ways we have of helping them.

Personally, the psychiatrists I know -- who are all just people with the same types of flaws and imperfections that all people have -- really care about their patients, respect them as human beings, and are interested in working with them collaboratively. I get insulted when readers insist my career is about power trips and that I'm wrong to say we shouldn't revel in the stories of patient victimization without knowing the full story. I'm not saying that psychiatrists don't make mistakes, or that their aren't bad psychiatrists, and I'm certainly not saying that there are not bad laws out there, but I am saying that our field is not about evil people (they are the exception, not the rule), and power trips. One should reserve judgement when all sides can't weigh in. A psychiatrist simply can't tell his side of the story to the media. "I was hospitalized unjustly!" can't be countered in the media by a psychiatrist saying, "He insisted he was going to kill his family." What I'm lost for is why the "Psychiatrists are Evil" crowd congregate here at Shrink Rap. Do they think that the incessant drumbeat of "psychiatry is evil" in the comment section of a blog changes the world? It doesn't, it just annoys the bloggers and adds to this odd notion that a therapeutic relationship with one's doctor is adversarial, when we see it as being collaborative. It's exhausting and eroding. I believe that if the commenters want to change the world, they should start their own blogs for like-minded readers, and when they believe someone has been victimized by bad laws, they should write the newspapers and legislators in those states and protest the bad laws. The comment section of Shrink Rap does nothing, nada, zilch.

44
comments:

Wow, Dinah. A lot here. What comes across from some of these posters is that there is one side of an issue and the other side does not exist. Nothing that is written in explanation moves them one bit.

But the sense that the patient is always the victim, that the actions of others are always abusive, is a reflection of the attitude that these posters have in general. It hurts them a great deal and influences their own success in dealing with the world, coworkers, neighbors, and so on. They suffer from it.

The other side is that there are so many posters on Shrink Rap who are thoughtful and try to understand the opinions of others. They are enjoyable to read and make this a great community. They may have really suffered through various experiences but they don't paint all psychiatrists with the same brush. They see variation and nuance.

I hope they keep posting and think that they do get something good out of this community.

Here is a film. Imagine that the couple in it drag their stuff over an old man who feels attacked and as they are in a Stand Your Ground state, pulls his gun. Luckily he is tackled in time and all brought to an ER. The psychiatrist gets a history from each. What does the couple say in explanation? What does the old man say?

I liked Jesse's link to the outdoor movie. That couple needed to get smacked down by an old codger. If an old man did pull a gun after they ran him over with all that crap, I would hope the psychiatrist would thank him for his wonderful public service. I know the doc can't do that, but still, my thinking is that the pdoc would realize (hopefully) that the old man was just messing with them. Unless he was psychotic, he wasn't gonna be pulling the trigger. And that had nothing to do with stand your ground. You have to be in fear for your life for stand your ground to take effect. At least that's what I thought. You can't just pull a gun because someone accidentally hit you with their stuff or even gave you a little slap. I thought you have to have a reason to think that your life is in danger. It's like the Castle Law. You can shoot anyone who breaks into your "castle" because you have to assume they are going to kill you. Sure, they might just wanna steal some beers. But a break in is a real reason to be in fear for your life.

Anyhow, the pdoc is the objective third party in this scenario who has to gauge the truth based on two biased sides. The anti-pdocs, from what I can tell, aren't saying someone else wronged them, painted them as crazy, and convinced a pdoc to lock them up. They are saying the pdocs had an agenda and there was no third party to call them out on it. I know this is what judges and commitment hearings are for. If the doc is on a power trip, hopefully the judge will see through all the handwaving and medical jargon. I do wish, when commitment is an issue, that there could be another body, outside psychiatry, involved right away. A lot of pdocs are not thorough and just rubber stamp what the last pdoc said or did.

The comment section is a validation for those who get away with writing inappropriate comments that don't get censored. I have been reading and writing at blogs for 4 years now, and sites that don't moderate up front or respond with harsh rebuttals, well, are the feeding grounds for the antipsychiatry and plain characterological people that thrive on anonymity and plain unaccountability.

But, I think the authors here know that. It is about numbers, let's have a moment of frank candor.

Yes, I should know better than to comment as well, but, this needs said!

Jesse, I tried to watch on my phone and computer but couldn't.P-K: your shrink does not sound one bit evil or power-tripping.Joel: it's not about "numbers;" I sometimes wonder if NOT moderating chases commenters away. But psychiatry has been accused (and perhaps rightly so at times) of shutting down those who criticize, hearing only what it wants to hear, and so we Shrink Rappers have had many talks about this and have decided that a) we learn something from those who are critical and b) we don't want to be one more place where psychiatrists don't listen respectfully.

But every once in a while, I do feel eroded, and I usually post something anti-hater, and it usually quiets people for a bit...just alters the tone a little, and I felt like it was time.

I do want people to put links up to interesting, thought provoking stuff. It's fine to say "hey look there's this poor lady in VT who was held for over a month." That's fine. And it does make me wonder about their laws and how that could be. What I don't like is when people then move from making us aware of the story, to saying --without knowing what the psychiatrists here perceived, or the details of any victimized patient's behavior (and I don't mean to stay on the VT woman who so tragically lost her son and husband) -- I don't like it when people come here to show that and move right on to "the psychiatrist is evil and on a power trip." No one likes it when psychiatrists draw conclusions without hearing the perspective of the patient, so I'd like our profession, for the sake of our blog, to be afforded the same respect. I don't think that's too much to ask.

Just read Psycritic's referenced blog and all the comments. Very impressive and it does feel good that our profession has such thoughtful and knowledgeable practitioners. One (just one) difference between psychiatry and the other medical specialties is that they deal with parts of a person, e.g. "my eye" while psychiatry deals with "me." Vastly more difficult to understand, much more threatening, and generally requiring a lot more time. This last element, time, cannot be put in a bottle or doled out quickly.

A cookbook approach which defines parameters in rigid forms cannot help everyone. Our field takes thought and hard work whether we try to help patients in a private office, a hospital, or (like Clink) even in a prison.

Sometimes just being with another person is the greatest benefit we can bring to them. The field is so complex, but humans are complex. There is no shortcut.

Recently I saw the film "The Invisible Woman," a film with Ralph Fiennes and Felicity Jones. It is the story of a young, briight 18 year old actress who gets into an affair with the great writer Charles Dickens. He is a great writer but also an utter narcissist who thinks of nothing but himself. It almost destroys her. She cannot tell anyone what happened. She is saved by her local vicar who recognizes her and offers to listen non-judgmentally. See the film, but there is a black box warning: you will see that the man who created Pip and Oliver Twist was so in love with his own image it almost destroyed those he loved (and I'm including his wife in this).

No DSM codes, no medication, no putting her into a box. Yet there are also people helped by a little medication who were in therapy for years without improvement.

I am glad we have such thoughtful people in our field, doctors and patients, who often post here. The dialogue is essential.

Dinah, regarding your suggestion that someone like me write a blog about my negative experiences with psychiatry, I don't have the cognitive power to do that which I can't totally blame on the psych meds I took. I think I come here because I get to use my reasoning skills which I enjoy doing, particularly if I am dealing with different points of view.

And you may not realize it but I think some of the commentators have caused you to reevaluate your position. It seemed initially, you thought that psych hospitals were a mostly positive experience and seemed to not realize how traumatic they could be for people. But you seemed to change your position on that.

I guess what I am saying is that my hope in coming here is not that I will get you to become a Peter Breggin. That aint happening:) But I hope at least I can get you to move from point E to point D in your views on an issue.

Ok, regarding the blog entry, you may not like what I am about to say but here goes. I do thing some psychiatrists are evil, particularly ones that are giving electroshock to kids and yes, that does occur.

I also think putting someone with any disorder on 13 meds is evil and in my opinion, it occurs more than you think.

Here is what I am hearing in your blog entry and in my conversations with doctors regarding current regular medical issues I am dealing with. I think physicians think medicine is great most of the time and any bad experiences are rare whereas many patients have a different view and find it hard to get heard by their doctors. It leads to very frustrating communication as it feels to me the doctor is on a power trip because of the MD by his/her name and not listening to what I am saying.

And by the way, this happens even though I try to be very respectful. But I get the sense that I should shut up and be quiet even though the issues I am asking about are about my life.

I have said to people that it is harder to get information out of doctors that I have a right to know about than getting secrets from Al Queda. That is just not right.

Ok, back to the topic. I understand why you feel the way you did. Psychiatrists and mental health professionals who found Whitaker's book accurate initially said they didn't want to believe his research and did everything they could to try to refute it. They felt like they were punched in the stomach.

I know if I believed in something and there were people out there trying to discredit it, I would find that hard so I do understand where you are coming from.

Anyway, I think this is one of the longer posts I have written. I will blame it on the snow. LOL!

I think it is easy to take criticisms of Psychiatry personally as a psychiatrist. I think what a lot of folks have experienced which is so maddening is not necessarily an unfortunate interaction with an "evil" psychiatrist, but their experience with an educated, caring professional that still led to harm. It is the realization that it didn't have much to do with the individuals involved, but could have happened to anyone and can still happen because the power dynamics at play. This is not saying psychiatrists are on "power trips," but just by nature of doctor/patient relationships, legal power invested in psychiatrists, power of diagnostic labeling, socialization to defer to doctors even you disagree, disagreement being labelled illness, etc., folks feel hurt by their participation in a rigged system they didn't previously understand.

You say that the psychiatrists side is not presented when folks talk about their bad experiences. I think in context, people comment because it is Psychiatry that always has a voice to define and shape what people's experiences are (and should be).Folks are trying to tell a different story in their own terms. Your right, it is not the "full story," but we are used to hearing mental health professionals POV on our stories that generalize past our individuality and are frequently demeaning and invalidating. I think we are trying to put out the content that there is a different story and that is valuable for mental health professionals to listen.

As an aside, psychiatrists don't often tell their patients the "full story" when there is disagreement or feelings of victimization. That would go a long way too, instead of often hiding in "blank screens" obfuscating process, not discussing why they choose what elements go into treatment, etc. Being more upfront and more consistently engaging consent would go a long way.

It is great that you offer a space to hear other voices and listen respectfully. You're right that commenting doesn't change much. Folks are hurting though and the ones they were told could be trusted for help they now realize cannot be. Even Jesse's more subtle and Joel's more overt claims of characterological problems in folks who comment is an example of folks with psychiatric power being able to without much thought to tell the stories of other people who they don't know in a way that is demeaning and invalidating, while folks who tell their own stories are considered "not telling the full story."

Nathan: I have NO problem with people telling their own stories from their perspective. "This is what I experienced and this is how I perceived it." I certainly don't expect every commmenter to send their psychiatrist to Shrink Rap to tell the other side of the story!

What I was referring to was readers posting media links (which I like, don't stop), and saying look at this poor soul victimized by psychiatrists by the treatments forced upon them, when we can never hear the other side. Pt forced to have awful distasteful treatment, but there is the possibility (which we can never know, and which may not be) that other options were tried, that the patient's symptoms were horrible, dangerous, and intractable. We just don't know. But to deem psychiatrists as evil and on power trips based on media stories told only from the patient's point of view is not reasonable. And to lump all shrinks together based on the fact that some are insensitive, too rushed, appear uncaring?

Anon: yes, I have moved in understanding that some patients who've been committed feel traumatized by it and in understanding that some people feel dismissed and unheard. In my practice of psychiatry, this has made no difference -- I do outpatient work in a state with no forced outpatient care. But the bigger problem for psychiatry is that the large majority of patients on psychiatry units are voluntary, and we don't have enough beds for those patients. Many of my patients have had hospitalizations in the past, many say they were lifesaving, none say they were 'abused.' As a student/resident, I rotated through many psych units in many states (calif,minn, pa, several in NY, maryland), spent hours a day for weeks on these units, and never once thought "I'd rather be dead than be a patient here." Was every interaction I witnessed wonderful? Of course not. I did rotate through many medical units where I thought I could never stand to be so powerless and at the mercy of others for when I got pain relief, food, medications (with the hopes that the right pills were delivered), and help with mobility and hygiene. Ugh.

I believe ALL doctors have been guilty of dismissing their patient's complaints of side, not so much because they are evil, but because often there is nothing to do. Steroids have horrible side effects but they enable air exchange: you're choice, oxygen or side effects, and if there's another medication that will work without the side effects, that's usually tried first. Same with psych issues, you don't have to be on a medicine with intolerable side effects (and you shouldn't be if it doesn't work), but from the docs point of view, if there isn't something better to offer and the medicine works to keep a patient out of the hospital, or not symptomatic, the risk of trying something else (if it hasn't already been tried) is the risk of relapse. Believe me, if we could offer medicines with no side effects that worked all the time, we would.

The risk benefit discussion is hard -- my experience is that most people tolerate sSRi's, that doesn't mean any individual patient will. And since there are a zillion possible side effects, I only review the ones I see most commonly, the black box warnings, and any really bad things associated with a medicine. I do assume that the pharmacy hands out a list of possible side effects (they do when I get a new medicine), and that Google is available to all.

I have had both a great psychiatrist and a narcissistic psychiatrist. The narcissist , I just got meds from him and did counseling with a psychologist. My psychiatrist of the last 3 years is amazing. I do therapy with him and am making great progress. I am not saying he is perfect. In fact, his openness about his imperfections in therapy has been a good role model for me. It is when we clash that I experience the most growth. I think the "psychiatrists are evil" crowd often come from Scientologists, where some of their ideology originates from the teaching that "psychs" are evil people who want to take over the world. In fact they have a museum about the psychiatrists being responsible for the Nazi holocaust. Why? Actually their founder, LR Hubbard's methods were rejected by the psychiatric community (for good reason) and he wanted revenge. So his manta was attack, attack, and never defend! They are starting to fall apart, so hopefully they will become totally irrelevant soon.

I have a couple of agendas for posting on here as a patient who is unhappy with psychiatry. I do have a psychiatrist and I like that psychiatrist.

First, I'm going to mention to Dinah & other psychiatrists that when I observed serious abuse inpatient, it was NEVER EVER done in front of the doctors, and usually the RN's weren't there either. This was on purpose - the aides knew when the doctors and RN's were gone or in the glass cage doing paperwork. Based on their behaviors, these abusers literally hated the patients. I saw them repeatedly verbally taunting a war veteran with PTSD for example.

Other times, such as at a very nice, religious hospital, the staff were kind, but had NO training on de-escalation, and would constantly escalate patients who had dementia or could not speak any english. Then they would tackle them and inject them day after day, as the patient dramatically deteriorated. It was horrifying. I believe the staff had PTSD from that - they cried as they tormented patients. The patients were doing nothing but hang around the front door - no threat to self or others. Most staff would just use the back door instead since mental patients almost never get any visitors anyway. Staff from other departments who rushed to tackle these patients would arrive, laughing and talking excitedly as if they were arriving at a Christmas party, and leave in the same JOVIAL mood, with their cute pediatrics scrubs on, all rainbows and puppies. But the mental health staff were a ruin after they injected these beautiful people and dragged them off screaming into isolation where they were stripped. I took careful notes in order to file a complaint and was housecleaning recently and found my letters to the facility administrator and cried all over again about what happened. I don't know if things were improved or not. The administrator seemed more concerned that I should not have been there as a witness rather than concerns about escalating people. Hush it up. The hospital accreditation people only cared if razors were sterile or not, I kid you not.

To be fair to administrators, in every case where I complained, my complaints were all substantiated by staff, and those hospitals made changes. I don't know if the culture changed, is the problem.

I do not like the trend where anonymity is being taken away on comments on many websites, because then I won't comment there. I notice on those type of sites (e.g. newspapers) that NO mental patients comment on psychiatric stories. Was the comment above worth knowing or not? Nobody but a mental patient would have made a comment like that.

I comment here because I have agendas - I saw patient abuse and most of those folks were unable to advocate on their own behalf (dementia, speak no english). The abuse was done when the doctors weren't there. (A couple times, the doctors were at fault too for other things). So I inform psychiatrists of what happens behind their backs,for those doctors who really care, which I think most do.

My other agenda originally was to inform psychiatrists that sometimes the drugs make people a lot worse off, as happened to me, but that message has been out awhile now after Whitaker's book came out. Of course, the 15 years I got worse and worse, the doctors uniformly said it was "my illness." It's only after the fact, not that I'm off those drugs a long time, that any doctor agrees that the medications were the problem, and all who have seen me before and since agree that's so. Unfortunately, I'm left with my original problems, but at least I'm easy for others to get along with again. I'm sorry that psychiatrists couldn't help me, but what makes me angry on my own behalf was when a few (most did not!) blamed me for the problems, repeatedly, calling it a personality disorder, and it was the drugs they were feeding me causing my behavior problems, which suddenly materialized in my 30's.

When I help others with their medical problems that require hospitalization (e.g. surgical patients)the nurses and doctors are so kind, it makes me cry how horrible it is for mental patients when inpatient, in comparison. Disrespectful treatment by many staff (no all!), strip searches, no visitors, no flowers, no telephones (ok, share 2 phones on a floor with 20 patients, but the teens need the phones to call their mothers, and who is going to kick a kid off the phone?) and so on. It even comes down to the mental patients pass around a couple bottles of shampoo, but the surgical patients get their little individual bottles of shampoo. LOL I could not believe it! (I am thrifty and applaud cost saving measures, but why always the mental patients?)

They congregate because you generally negate the experiences. I've read it time and again. Roy and Clink are not as bad but you are always at pains to point out that you are good, benevolent, helpful - and anyone who disagrees is wrong. You think you counter this by saying you know some shrinks are not perfect; this is negated by all teh times you insist on it otherwise. Your posts are like insult to injury and it's hard to not think maybe THIS time I can explain it and she'll get it...nope.

Catlover: If it helps you to vent about your awful experiences, all the more power to you.

M: I believe it was Einstein who said insanity is doing the same thing over and over and expecting different results. I'm not sure why come to a blog that aggravates you, I find it better to avoid such things. Maybe you can find a blog by a psychiatrists who claims to be unkind, on a power trip, who offers miserable care to miserable patients and admits to being evil? Here at SR, all three of us are good and mostly benevolent (if you tried Roy's new cookie recipe, you would definitely wallow in his benevolence. We try to be helpful, but as Einstein's mother probably said, "you can't please all of the people all of the time."

I believe that psychiatrists have more depth of character than most doctors (especially surgeons!). My son sees a wonderful psychiatrist here and San Jose for OCD/anxiety issues. I think some religions are really suspicious and ignorant about therapy. I'm a recovering Mormon (25 years) and I recall recommending a psychiatrist to the family of a high school Mormon friend because she was starting to show signs of schizophrenia. Her dad accompanied to the appointment and asked to say a prayer in the room before any "head shrinking" occurred. Oy vey!

Nah, he's not one bit evil. A really nice guy, actually. I think even the anti-psychiatry folks would have a hard time disliking him. I'm lucky to know him.

I do have strong opinions about involuntary treatment, but that doesn't mean I believe psychiatrists who do this are evil or on a power trip. I believe most are trying to do the right thing, even though I don't believe involuntary treatment for those who are only a danger to self is the right thing. To that end, I support increased oversight over these decisions and encourage people who may see a psychiatrist or therapist to find out what their stance is on these issues before it becomes an issue. I have done this with my own psychiatrist, and I'm satisfied with his answers. If I had had him as my first psychiatrist, I doubt I would think much about involuntary treatment as he would have handled things very differently.

I met with a shrink once and had a feeling that he was getting off on the horrible traumatic stories I was sharing. Then I started thinking he was a serial killer of small children, and there was a dead child in the office. Though I was shaken by this, luckily, I was aware enough to know that I was having a delusional episode thanks to my PTSD. I'm sure he's actually a pretty great guy. I also decided I should switch to a female shrink -- she didn't trigger me when I talked about my abuse history. Hard lesson learned. I can laugh about it now, but it was very distressing at the time. Despite how this sounds, I'm a very sane and stable person. I'm sure there is something in the power dynamics, gender (same as my abuser), retelling my history, and complex PTSD with secondary psychosis that literally made me think my shrink was evil. Wow. On the contrary, 50mg of Zoloft and I'm a brand new person. I don't have any rapport or interact much with my shrink to speak of, but she has made the most significant contribution to my quality of life that has ever happened. That and a fantastic therapist, and I owe my life to your profession. So, thank you!

A victim, as defined by Merriam-Webster, is someone that is harmed by an unpleasant event - someone that is subjected to oppression, hardship, or mistreatment. So, while the patient isn't always a victim, judging by the numerous stories of harm, real or perceived, involving encounters with the mental health system, patients are victims more often than you are willing to credit.

That denial leads to one of the central issues involved in this polarization of opinion on psychiatry: Blame. It's always the patients fault, even when it's not. Yes. I refer to "the poor lady in VT". In your previous post (Insurance (or not), Flotation tanks, and involuntary commitment), I tried to outline my thoughts on the matter, and the posts there from psychiatrists were illuminating, to say the least. To recap: a judge ruled that this woman was held without proper cause (which, by the way, makes her a victim) and both you and Dr. Reidbord attempted a defense via disclaimer; i.e. 'we don't know the whole story". But, we know enough - the authority to commit rests in law, and an arbiter of that law ruled the hold improper. That should have been enough, but it wasn't, apparently. You say that you'd like your profession to be afforded respect, but at the same time, you question the decision of a judge on a legal matter? In his area of expertise?How about respecting his opinion? His profession?

This leads to a kind of self-righteousness, and an assumed authority that exceeds boundaries. Look at Dr. Reidbord's response in the previously mentioned post - he claims that the power to initiate a hold is equal to the policing concept of probable cause. Probable cause, however, allows arrest when known facts cause an officer to believe a crime has been committed; not on intent to commit but on actually committed - note the past tense. Psychiatrists actually have more leeway in arresting than the police do - and yes, arrest is the right word. "A rose by any other name" is a valid observation here.

Then there's the semi-veiled hostility in some of the psychiatrist's posts here, principally Jesse and Joel Hassman, MD. Nathan's post already touched on that subject, and quite well I think. I just want to add that those posts remind me of the Rosenhan Experiments - proof that if all you have is a hammer, everything looks like a nail. To paraphrase - if all you have is psychiatry, then everyone appears mentally ill. Characterological indeed. Since characterological relates to the character of individuals and the differences between them, of course its characterological. Everything everyone does is according to their character. Perhaps the reference is to characterological vs. behavioral self-blame? I don't know, this statement seems to be a catch-all bunker position; a go-to statement when there is nothing else to offer. A lashing out, so to speak. That's how it comes across, anyway; but then, I'm not a psychiatrist, I haven't undergone the apotheosis, so perhaps this has meaning beyond the mortal sphere that I reside in. Maybe. Or maybe not.

Catlover, you are always welcome here, and we are happy to have you.Your commentary will not, however, change the world and if you'd like to do that, there is a better chance with your own blog, or better yet, by lobbying state legislators.

JeSuis: you are saying the same thing over and over, and you should also have your own blog. Your insistence that psychiatrists are evil persecutors is inappropriate to this forum and I am deleting your comments from here on. Those who agree with you already agree with your and this is not the correct for it. Those who do not agree with you feel intruded upon and annoyed by your tunnel vision. Please find another forum.

While I think we all know that statements like "all psychiatrists are evil" are caricatures at best that no one actually believes (that everyone who has completed a residency in psychiatry is an "evil" person, whether they chose psychiatry because they were evil to begin with or became evil in their residency). I don't mean to take this lightly, I believe that threats of violence should be taken seriously. But if someone says such a clear blanket statement, I don't see it as much different than "all politicians are evil or corrupt" or "all lawyers are slimy." No one actually believes this, and moreso, politicians and lawyers do not get all that offended or worn down when they here such claims.

With further thought, "evil" can be considered a description of character. Perhaps psychiatrists don't like hearing their character being maligned and scrubbed of nuance because of a label they have (psychiatrist). Perhaps this discomfort leads to lashing out of calling people "characterological" or "personality" disordered. Or maybe it works the other way too, being reduced to character or diagnostic labels leads to lashing out against the folks who assigned them.

I wonder if monikers of "evil" and "characterological" or "personality disordered" etc. have just become back and forth name-calling. The main difference is that mental health professionals can get the labels they assign to stick in records and psyches that have very real life consequences, and other folks can always have their comments deleted on a blog that admittedly by Dinah isn't consequential anyway.

I will close my comments on this topic by saying I haven't seen much of "all psychiatrists are evil" crowd on Shrink Rap. Maybe their comments get moderated and are never seen, but my suspicion is that "all psychiatrists are evil" posts are more like a straw man urban legend that psychiatrists toss around (not unlike "secret Scientologist") that serves to mark any criticism of their work or the social/legal structures they work in as invalid or dismissable. Even more, if labelled part of that crowd, it frees mental health professionals from having to engage with any criticism or argument they don't want to engage in and not have to think so critically about their own work if they don't want to.

I apparently was mistaken about warrantless police arrests. Although intent to commit a felony can add to criminal charges (e.g., possession with intent to sell drugs, assault with intent to kill), probable cause to believe a misdemeanor or felony has already occurred is needed to justify a criminal arrest. I apologize for the error, and agree that psychiatric holds differ from criminal arrests in this way.

"Then there's the semi-veiled hostility in some of the psychiatrist's posts here, principally Jesse and Joel Hassman, MD."

I don't know so much about Jess, but there is NOTHING semi-veiled in Joel's responses. He is very openly hostile. And I'm starting to get really offended.

"Characterological indeed. Since characterological relates to the character of individuals and the differences between them, of course its characterological."

No Je Suis, Joel meant personality disordered and used the word characterological. In fact, it seems that everyone Joel doesn't like, including patients who give him dirty looks, are Axis 2. These aren't even my words. This is stuff that he has actually said on this blog in the past. Only Axis 2 people look at him with hatred on inpatient units. It is not possible that some of these people just genuinely don't like him.

Frankly, I think if Je Suis is banned from this blog, then Joel should have been banned about 20 posts or more ago.

I was actually happy when Joel came on once and said he was done at this blog. I thought, Finally! And then he actually came back!

Nobody thinks it changes the world. People think it might change the negative parts of YOU.

But it doesn't, because you are incapable of hearing what is being said if there is any intimation whatsoever that you might be in the wrong. Or, even, that you might be able to be better. You, great god-like Dinah, are always in the right. We silly patients should know better then to dare to think otherwise.

something else - Although Dr. Hassman's honestly is more brutal than suits my taste, if you look at the body of his work and his comments, you will see that he is actually fighting for the benefit of patients, and that his ire is just as strong, if not stronger, for those in his profession.

Nathan - There is a strong anti-psychiatry crowd, maybe not here, but if you spend any time on Mad in America you will plainly see it. The one huge issue I have with them is that they are high on anti- and short on pro- In addition, many times they make no sense. Case in point, the woman that was involuntarily detained in VT, although I feel for her experience, was vindicated by a law already in place. Now she fights for new legislation against involuntary commitment.

Excerpt of her testimony from USA Today, "I had patients throw chairs at me. I had this woman sit outside my room who was mentally ill and needed more help then she was getting," Schumacher told the senators. She said the woman would scream obscene comments.

So, get rid of the involuntary commitment altogether, for what, so the mentally ill woman could sit on the street outside her home under her bedroom window yelling obscenities?

This isn't to bring up the commitment/non-commitment argument here. It was only an example of how the anti-psychiatry crowd needs to figure out how to get viable alternatives to what exists today vs just bashing psychiatrists. If they come up with that, they won't need to bash psychiatrists, they will either change or become irrelevant.

If they get their wish through turning the tide against psychiatry or even something like budget cuts, and no alternatives exist, they had best be prepared for how society will treat them. Things can get worse than they already are.

Not a Doctor wrote: "This isn't to bring up the commitment/non-commitment argument here. It was only an example of how the anti-psychiatry crowd needs to figure out how to get viable alternatives to what exists today vs just bashing psychiatrists. If they come up with that, they won't need to bash psychiatrists, they will either change or become irrelevant. If they get their wish through turning the tide against psychiatry or even something like budget cuts, and no alternatives exist, they had best be prepared for how society will treat them. Things can get worse than they already are."

This is very important. I remember when the mental hospitals were closed with the promise of community clinics, which never came. The prison system became the de facto hospitals. There have been comments on SR at times that said that the problem is the psychiatrists, that they had potential power to commit patients, whether they used it or not. Well, every citizen has that potential power, and if a person is acting strangely or in a way to disturb the public there is always the chance he will be arrested, charged, and end up in conditions far worse than what any psychiatric action could do.

Those of us psychiatrists who post and comment here are interested in helping people, and Dinah is one of the more active and vocal in this regard. And I agree that Dr. Hassman has patients' interests in mind. He is blunt but good-hearted and I bet his patients feel lucky to have worked with him.

To be fair to the folks at Mad in America, there is a segment, mostly therapists but not exclusively, writing about what works to heal people or the research being done to find it. Interesting stuff and far more helpful than the constant bashing.

My psychiatrist is great. I've met a lot of great psychiatrists. I've also met some that need to evaluate their career choice.

Psychiatrists may very well get hit hardest with criticism of medical professionals. It makes sense - people don't want to feel like their emotions are being pathologized or reduced to biology (read: like animals). Psychiatry has a nasty history, with eugenics, racism, sexism, heterosexism, patient abuse still occurring albeit not nearly as much as previously. It's been fairly recent that psychiatry has softened and become increasingly patient-focused. Many people who experienced things like patient neglect, ECT without anesthesia, extensive chemical/physical restraints, etc. are still alive. And not all parts of the US have benevolent psychiatric services - there are parts of the country with psychiatric hospitals out of One Flew Out of the Cuckoo's Nest.

It takes time to heal from a history like that. As for why people with a generally negative perception of psychiatry comment on this blog (Even with my commentary, I'm not one of them - medical professionals are generally good people in my opinion), depends I suppose. I suspect some of them are trying to point out that psychiatry has not been and is not always focused on healing.

Is that above link by Dinah from what John Grohol wrote about a couple of days ago at his site www.psychcentral.com/blog ?

I linked about it regarding my post related to this one a couple of days ago.

By, the, way, I think some people here don't like me because I hit a nerve. Keep them covered, folks, I am not interested in pleasantries nor respect for abuse by the usual suspects here. Dinah et al might be in their living room here, but, at my site, I am out in the field. No controlled environments there.

In the case of Justina Pelletier, it has been extremely evil in my opinion. Just do a google search about parents losing custody of their 15 year old because they disagreed she had somataform disorder which was the diagnosis of Boston Children's Hospital. Tuft's Hospital, obviously, not Bob's medical center had diagnosed her with Mitochondrial disease which her older sister has by the way.

Anyway, now it looks like they have permanently lost custody.

And for the other side Dinah, look at the pictures on various news stories of her previously being able to ice skate and now being in a wheelchair. And why is the father risking going to jail over violating a gag order if he wasn't worried his daughter was going to die?

Also, see this comment by Bronwyn Lommel on this page, http://www.opposingviews.com/i/health/massachusetts-takes-custody-teen-denies-her-treatment-her-disease, who had a similar type experience at Boston Children's hospital where Justina was diagnosed with Somataform disorder. Apparently, this hospital has a history of doing this.

I also think there are many other evil parties on all of this and that psychiatry isn't the only guilty party. But it doesn't absolve them of their role in all of this.

As a mental health professional and a newcomer to your blog, I wish to commend you for your thought-provoking commentaries, and for providing an open forum for discussion. The topics addressed here are often those discussed during lunches or coffee breaks in mental health centers, hospitals, and office-based practices throughout the country, and the opinions you present strike me as both balanced and scholarly. I'm sorry to hear that your site has been plagued with negative and counterproductive comments, but frankly, I'm not at all surprised. Over the years, I've had considerable dealings with anti-psychiatry people of varying stripes. Many such people are disgruntled patients, resentful of medication side effects or of the involuntary commitment process. Some of these people are members of certain anti-psychiatry religious groups, but the largest of these groups is comprised of the woefully uninformed - those who see mental health treatment as a farce or scam perpetrated on a gullible and self-absorbed public. Obviously, each of these groups is entitled to their opinions, and there is, admittedly, a kernel of truth to their views. After all, psychotropic medications often do have untoward side effects, and on occasion, these effects can be devastating. Furthermore, the commitment process is admittedly coercive and unpleasant, and probably more so for the patient than for the clinician. And of course, there are some (but not many) mental health professionals who are obvious charlatans and who do, indeed, take advantage of their patients. But a kernel is only a kernel. The truth is that mental health professionals have chosen a noble endeavor, one that eases the suffering of many - and which does so at some cost to the professional. There are many among us who have spent long hours agonizing over whether they should have prescribed medication (or not), whether they made the right decision to admit (or to discharge) a patient, or even whether their patient will survive the week. There are others among us who have lost sleep because of the prejudices that their patients face, sometimes even from their own families, and there are others who feel chronically weary and unempowered from years of battling for their patients in an under-funded and fragmented community mental health system. And finally, there are some among us who bear the physical and emotional scars of having been severely assaulted by people that they only wanted to heal. No, mental health professionals, including psychiatrists, are not inherently evil. They are imperfect, as are all members of our species. At times, they make mistakes, and because they live in an imperfect world, with imperfect laws and imperfect systems, at times, despite their best efforts, they will fail to help their patients. I'd like to believe that the anti-psychiatry groups would take this information under consideration, but I'm admittedly somewhat less than optimistic about this. Perhaps that's because I, too, am imperfect.

Anonymous Newcomer - Take heart. In all the years I worked in a general hospital, for the bad outcomes I saw, there never was one point of failure. However, I did see many cases where the acts of one individual made the difference to a good outcome.

1- Yes, I do believe that psychiatrists are evil. I do not buy the idea that "most care about their patients". But let's give you that for the sake of argument . As CS Lewis said "of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive". So even if psychiatrists are really like you portray them here, they are still evil for believing that they can force their invented diseases onto people "for their own good".

The reason survivors complain here and similar blogs anonymously is because the law is stacked up against us. If we were to post with our real identities our true feelings against the psychiatrists who wronged us -even though posting said feelings would have no legal consequences for a "non mentally ill person" -, that could be used by evil psychiatrists to continue their abuse on us. We might be "mentally ill" but we are not stupid :-).

And to add to the other anonymous posters, the final thing you wouldn't get even if you were to simulate the whole thing as faithfully as humanly possible (with restrains, forced drugging, etc) is this.

While the author concedes that indeed,

"2002 UPDATE"The ADA [Americans with Disabilities Act] was passed in 1990, prohibiting employers from discriminating on the basis of disability, including mental disability. Employers may no longer ask applicants about their mental health and hospitalization histories. ... The best the ADA has been able to accomplish is to change the workplace from one where applicants had to affirmatively lie about their psychiatric histories and diagnoses to an environment of 'don't ask, don't tell.' ... when it comes to psychiatric disabilities, it would be fair to conclude that the ADA has failed to provide a remedy against employment discrimination." Susan Stefan, J.D., Hollow Promises - Employment Discrimination Against People with Mental Disabilities (American Psychological Association, Washington, D.C., 2002), pp. xiv & 19-20. Susan Stefan is an attorney at the Center for Public Representation in Newton, Massachusetts. Until 2001, she was a professor of law at the University of Miami School of Law, where she taught disability law and mental health law. She graduated magna cum laude from Princeton University in 1980, received a master's in philosophy from Cambridge University in 1981, and received her law degree from Stanford University."

The reality is that anytime somebody is officially "DSM labeled", he/she is stigmatized for life. And the stigma comes precisely from the scaremongering that organized psychiatry regularly engages in to ask for ever increasing powers (like the campaigns that promote AOT that propagandize about the "dangers" of untreated so called "mental illness").

So the best thing that people like you could do to help people like me is to switch sides to join anti psychiatry activism. Until that happens, you are still promoting mind tyranny. With better manners probably than somebody like E Fuller Torrey, but it is still tyranny.

There is a difference between identifying with or supporting "anti-psychiatry" groups/movements/thought and believing "all psychiatrists are evil/should die". This should not have to be explicitly stated but it seems that it needs to be. I don't think the latter "believers" exists to the extent the cadre of blogging psychiatrist believe they do (or at all as a meaningful crowd). I interpret the inevitable conflation between communities, groups, posts, etc. that are critical of Psychiatry with the elusive "all psychiatrists are evil" posts as an opportunity to avoid engagement with legit criticism and dealing with the unpleasantness of the realities at hand (it certainly can feel eroding to face those realities). Asking if someone is a Scientologist (or insinuate/accusing they are secretly one) or throwing around character disorder labels is another way to avoid discussion with ideas/people that are critical.

The Mad in America crowd is filled with thoughtful people working in the mental health system, participating in it, actively reforming it, actively building alternatives to it, avoiding it at all costs, and actively dismantling it. Some would consider themselves "anti-psychiatry". Many have been hurt by their experience with Psychiatry. Many are around today because of that experience.

Again, reducing people who have valid and lived criticisms to straw man comment posts about "evil psychiatrists" is an unfair and dismissive conflation. This happens on blogs where the stakes are low, but also in actual policy debate, in the clinic, and on the proverbial couch. The stakes are higher in these settings. If mental health professionals can't deal with them on a blog post, how do they deal with them when they are advocating with their associations, when determining organizational policy, or when talking with a concerned patient?

This post still upsets me. The title sets up a false yes/no paradigm only to be then righteously transformed. If anyone says "yes"--and no one really believes "yes"--then anything else they say is open to be derided as ravings of a disturbed and ignorant person. Anyone who is then associated with anything critical gets to be lumped in as disturbed and raving and their ideas or experiences are deemed not as worthy of consideration. If people say "no," then their comments of support and adoration are almost always welcomed and appreciated and are used to justify mental health practice as is. The discerning psychiatrist can then pop in to seemingly dissolve the paradigm by saying something like "there are some bad apples and no one is perfect, even psychiatrists," effectively rendering the question moot in the fist place and sectioning off all "evil" to unethical professionals and human nature. This makes them look fair or objective, but really serves to ignore discussion or self-criticism. The supporters support even more because of the seeming wisdom and self reflection in such a comment. It's also nice to feel like you're not a bad apple and mistakes you make are ok because everyone makes mistakes.

I've learned to spot the rhetorical questions like "are psychiatrists evil?" as evasive maneuvers that they are.